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Neumann S, Bauer CM, Nastasi L, Läderach J, Thürlimann E, Schwarz A, Held JPO, Easthope CA. Accuracy, concurrent validity, and test-retest reliability of pressure-based insoles for gait measurement in chronic stroke patients. Front Digit Health 2024; 6:1359771. [PMID: 38633383 PMCID: PMC11021704 DOI: 10.3389/fdgth.2024.1359771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Wearables are potentially valuable tools for understanding mobility behavior in individuals with neurological disorders and how it changes depending on health status, such as after rehabilitation. However, the accurate detection of gait events, which are crucial for the evaluation of gait performance and quality, is challenging due to highly individual-specific patterns that also vary greatly in movement and speed, especially after stroke. Therefore, the purpose of this study was to assess the accuracy, concurrent validity, and test-retest reliability of a commercially available insole system in the detection of gait events and the calculation of stance duration in individuals with chronic stroke. Methods Pressure insole data were collected from 17 individuals with chronic stroke during two measurement blocks, each comprising three 10-min walking tests conducted in a clinical setting. The gait assessments were recorded with a video camera that served as a ground truth, and pressure insoles as an experimental system. We compared the number of gait events and stance durations between systems. Results and discussion Over all 3,820 gait events, 90.86% were correctly identified by the insole system. Recall values ranged from 0.994 to 1, with a precision of 1 for all measurements. The F1 score ranged from 0.997 to 1. Excellent absolute agreement (Intraclass correlation coefficient, ICC = 0.874) was observed for the calculation of the stance duration, with a slightly longer stance duration recorded by the insole system (difference of -0.01 s). Bland-Altmann analysis indicated limits of agreement of 0.33 s that were robust to changes in walking speed. This consistency makes the system well-suited for individuals post-stroke. The test-retest reliability between measurement timepoints T1 and T2 was excellent (ICC = 0.928). The mean difference in stance duration between T1 and T2 was 0.03 s. We conclude that the insole system is valid for use in a clinical setting to quantitatively assess continuous walking in individuals with stroke.
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Affiliation(s)
- Saskia Neumann
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
| | | | - Luca Nastasi
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
| | | | - Eva Thürlimann
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Chris A. Easthope
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
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Mayrhuber L, Lestoille M, Andres SD, Held JPO, Luft AR, Ryser F, Gassert R, Easthope CA, Lambercy O. Movement Reminders to Encourage Arm Use During Daily Life in Stroke Patients. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941203 DOI: 10.1109/icorr58425.2023.10304727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Stroke is a leading cause of long-term disability, such as loss of upper limb function. Active arm movement and frequent practice are essential to regain such function. Wearable sensors that trigger individualized movement reminders can promote awareness of the affected limb during periods of inactivity. This study investigated the immediate effect of vibrotactile reminders based on activity counts on affected arm use, the evolution of the effect throughout a 6-week intervention at home, and whether the time of the day influences the response to the reminder. Thirteen participants who experienced a unilateral ischemic stroke were included in the analysis. Activity counts were found to increase significantly after receiving a reminder. The immediate effect of receiving a reminder was maintained throughout the day as well as during the study duration of 6 weeks. In conclusion, wearable activity trackers with a feature to trigger individualized vibrotactile reminders could be a promising rehabilitation tool to increase arm activity of the affected side in stroke patients in their home environment.
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Schwarz A, Al-Haj Husain A, Einaudi L, Thürlimann E, Läderach J, Awai Easthope C, Held JPO, Luft AR. Reliability and Validity of a Wearable Sensing System and Online Gait Analysis Report in Persons after Stroke. Sensors (Basel) 2023; 23:624. [PMID: 36679424 PMCID: PMC9862973 DOI: 10.3390/s23020624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
The restoration of gait and mobility after stroke is an important and challenging therapy goal due to the complexity of the potentially impaired functions. As a result, precise and clinically feasible assessment methods are required for personalized gait rehabilitation after stroke. The aim of this study is to investigate the reliability and validity of a sensor-based gait analysis system in stroke survivors with different severities of gait deficits. For this purpose, 28 chronic stroke survivors (9 women, ages: 62.04 ± 11.68 years) with mild to moderate walking impairments performed a set of ambulatory assessments (3× 10MWT, 1× 6MWT per session) twice while being equipped with a sensor suit. The derived gait reports provided information about speed, step length, step width, swing and stance phases, as well as joint angles of the hip, knee, and ankle, which we analyzed for test-retest reliability and hypothesis testing. Further, test-retest reliability resulted in a mean ICC of 0.78 (range: 0.46-0.88) for walking 10 m and a mean ICC of 0.90 (range: 0.63-0.99) for walking 6 min. Additionally, all gait parameters showed moderate-to-strong correlations with clinical scales reflecting lower limb function. These results support the applicability of this sensor-based gait analysis system for individuals with stroke-related walking impairments.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Adib Al-Haj Husain
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Lorenzo Einaudi
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Eva Thürlimann
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Julia Läderach
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, 8063 Zurich, Switzerland
| | - Andreas R. Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
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Deseoe J, Schwarz A, Pipping T, Lehmann A, Veerbeek JM, Luft AR, Wegener S, Globas C, Held JPO. Cerebral blood flow velocity progressively decreases with increasing levels of verticalization in healthy adults. A cross-sectional study with an observational design. Front Neurol 2023; 14:1149673. [PMID: 37139076 PMCID: PMC10149656 DOI: 10.3389/fneur.2023.1149673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Background Autoregulation of the cerebral vasculature keeps brain perfusion stable over a range of systemic mean arterial pressures to ensure brain functioning, e.g., in different body positions. Verticalization, i.e., transfer from lying (0°) to upright (70°), which causes systemic blood pressure drop, would otherwise dramatically lower cerebral perfusion pressure inducing fainting. Understanding cerebral autoregulation is therefore a prerequisite to safe mobilization of patients in therapy. Aim We measured the impact of verticalization on cerebral blood flow velocity (CBFV) and systemic blood pressure (BP), heart rate (HR) and oxygen saturation in healthy individuals. Methods We measured CBFV in the middle cerebral artery (MCA) of the dominant hemisphere in 20 subjects using continuous transcranial doppler ultrasound (TCD). Subjects were verticalized at 0°, -5°, 15°, 30°, 45° and 70° for 3-5 min each, using a standardized Sara Combilizer chair. In addition, blood pressure, heart rate and oxygen saturation were continuously monitored. Results We show that CBFV progressively decreases in the MCA with increasing degrees of verticalization. Systolic and diastolic BP, as well as HR, show a compensatory increase during verticalization. Conclusion In healthy adults CBFV changes rapidly with changing levels of verticalization. The changes in the circulatory parameters are similar to results regarding classic orthostasis. Registration ClinicalTrials.gov, identifier: NCT04573114.
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Affiliation(s)
- Julian Deseoe
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Theodor Pipping
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Aurelia Lehmann
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Janne M. Veerbeek
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Andreas R. Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christoph Globas
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- *Correspondence: Christoph Globas
| | - Jeremia P. O. Held
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
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Veerbeek JM, Pohl J, Luft AR, Held JPO. External validation and extension of the Early Prediction of Functional Outcome after Stroke (EPOS) prediction model for upper limb outcome 3 months after stroke. PLoS One 2022; 17:e0272777. [PMID: 35939514 PMCID: PMC9359545 DOI: 10.1371/journal.pone.0272777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The ‘Early Prediction of Functional Outcome after Stroke’ (EPOS) model was developed to predict the presence of at least some upper limb capacity (Action Research Am Test [ARAT] ≥10/57) at 6 months based on assessments on days 2, 5 and 9 after stroke. External validation of the model is the next step towards clinical implementation. The objective here is to externally validate the EPOS model for upper limb outcome 3 months poststroke in Switzerland and extend the model using an ARAT cut-off at 32 points. Methods Data from two prospective longitudinal cohort studies including first-ever stroke patients admitted to a Swiss stroke center were analyzed. The presence of finger extension and shoulder abduction was measured on days 1 and 8 poststroke in Cohort 1, and on days 3 and 9 in Cohort 2. Upper limb capacity was measured 3 months poststroke. Discrimination (area under the curve; AUC) and calibration obtained with the model were determined. Results In Cohort 1 (N = 39, median age 74 years), the AUC on day 1 was 0.78 (95%CI 0.61, 0.95) and 0.96 (95%CI 0.90, 1.00) on day 8, using the model of day 5. In Cohort 2 (N = 85, median age 69 years), the AUC was 0.96 (95%CI 0.93, 0.99) on day 3 and 0.89 (95% CI 0.80, 0.98) on day 9. Applying a 32-point ARAT cut-off resulted in an AUC ranging from 0.82 (95%CI 0.68, 0.95; Cohort 1, day 1) to 0.95 (95%CI 0.87, 1.00; Cohort 1, day 8). Conclusions The EPOS model was successfully validated in first-ever stroke patients with mild-to-moderate neurological impairments, who were independent before their stroke. Now, its impact on clinical practice should be investigated in this population. Testing the model’s performance in severe (recurrent) strokes and stratification of patients using the ARAT 32-point cut-off is required to enhance the model’s generalizability and potential clinical impact.
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Affiliation(s)
- Janne M. Veerbeek
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Johannes Pohl
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andreas R. Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Jeremia P. O. Held
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Schwarz A, Bhagubai MMC, Nies SHG, Held JPO, Veltink PH, Buurke JH, Luft AR. Correction to: Characterization of stroke-related upper limb motor impairments across various upper limb activities by use of kinematic core set measures. J Neuroeng Rehabil 2022; 19:70. [PMID: 35820923 PMCID: PMC9277818 DOI: 10.1186/s12984-022-01048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.
| | - Miguel M C Bhagubai
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Saskia H G Nies
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter H Veltink
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.,Roessingh Research and Development B.V., Enschede, The Netherlands
| | - Andreas R Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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Huber SK, Knols RH, Held JPO, Christen T, de Bruin ED. Agreement, Reliability, and Concurrent Validity of an Outdoor, Wearable-Based Walk Ratio Assessment in Healthy Adults and Chronic Stroke Survivors. Front Physiol 2022; 13:857963. [PMID: 35795644 PMCID: PMC9252290 DOI: 10.3389/fphys.2022.857963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose: The walk ratio (WR)—the step-length/cadence relation—is a promising measure for gait control. GPS-running watches deliver clinically relevant outcomes including the WR. The aim of this study was to determine test-retest agreement, reliability and concurrent validity of an outdoor WR assessment using a GPS-running watch. Methods: Healthy adults and moderate—high functioning stroke survivors (≥6 months), performed the 1 km-outdoor walk twice using a GPS-running watch (Garmin Forerunner 35, GFR35) and a Step Activity Monitor (SAM 3). Global cognition was assessed using the Montreal Cognitive Assessment. Test-retest agreement and reliability were assessed using Bland-Altman plots, standard error of measurement (SEM), intraclass correlation coefficients (ICCs) and smallest detectable changes (SDCs). Concurrent validity was determined by the mean difference (MD), standard error (SE), mean absolute percentage errors (MAPEs) and Spearman’s Rho between GFR35 and SAM3. WR values of the two groups were compared by a Welch’s test. A hierarchical multiple regression was performed with the WR as dependent variable and possible predictors as independent variables. Results: Fifty-one healthy adults [median: 60.0 (47.0, 67.0) years) and 20 stroke survivors [mean: 63.1 (12.4) years, median: 76 (30, 146) months post-stroke] were included. Test-retest agreement and reliability were excellent (SEM% ≤ 2.2, ICCs > 0.9, SDC% ≤ 6.1) and concurrent validity was high (MAPE < 5, ρ > 0.7) for those walking ≥ 1 m/s. Walking < 1 m/s impaired accurate step counting and reduced agreement, reliability, and validity. The WR differed between healthy adults and stroke survivors (t = −2.126, p = 0.045). The hierarchical regression model including stroke and global cognition (Montreal Cognitive Assessment, 0—30) explained 25% of the WR variance (ΔR2 = 0.246, p < 0.001). Stroke had no effect (β = −0.05, p = 0.682), but global cognition was a predictor for an altered WR (β = 0.44, p = 0.001). Discussion: The outdoor WR assessment using the GFR35 showed excellent test-retest agreement, reliability and concurrent validity in healthy adults and chronic stroke survivors walking at least 1 m/s. As the WR seems relevant in chronic stroke, future studies should further investigate this parameter.
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Affiliation(s)
- Simone K. Huber
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Ruud H. Knols
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University Zurich, Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
| | - Tom Christen
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- *Correspondence: Eling D. de Bruin,
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Veerbeek JM, Pohl J, Held JPO, Luft AR. External Validation of the Early Prediction of Functional Outcome After Stroke Prediction Model for Independent Gait at 3 Months After Stroke. Front Neurol 2022; 13:797791. [PMID: 35585839 PMCID: PMC9108182 DOI: 10.3389/fneur.2022.797791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe Early Prediction of Functional Outcome after Stroke (EPOS) model for independent gait is a tool to predict between days 2 and 9 poststroke whether patients will regain independent gait 6 months after stroke. External validation of the model is important to determine its clinical applicability and generalizability by testing its performance in an independent cohort. Therefore, this study aimed to perform a temporal and geographical external validation of the EPOS prediction model for independent gait after stroke but with the endpoint being 3 months instead of the original 6 months poststroke.MethodsTwo prospective longitudinal cohort studies consisting of patients with first-ever stroke admitted to a Swiss hospital stroke unit. Sitting balance and strength of the paretic leg were tested at days 1 and 8 post-stroke in Cohort I and at days 3 and 9 in Cohort II. Independent gait was assessed 3 months after symptom onset. The performance of the model in terms of discrimination (area under the receiver operator characteristic (ROC) curve; AUC), classification, and calibration was assessed.ResultsIn Cohort I [N = 39, median age: 74 years, 33% women, median National Institutes of Health Stroke Scale (NIHSS) 9], the AUC (95% confidence interval (CI)] was 0.675 (0.510, 0.841) on day 1 and 0.921 (0.811, 1.000) on day 8. For Cohort II (N = 78, median age: 69 years, 37% women, median NIHSS 8), this was 0.801 (0.684, 0.918) on day 3 and 0.846 (0.741, 0.951) on day 9.Discussion and ConclusionExternal validation of the EPOS prediction model for independent gait 3 months after stroke resulted in an acceptable performance from day 3 onward in mild-to-moderately affected patients with first-ever stroke without severe prestroke disability. The impact of applying this model in clinical practice should be investigated within this subgroup of patients with stroke. To improve the generalizability of patients with recurrent stroke and those with more severe, neurological comorbidities, the performance of the EPOS model within these patients should be determined across different geographical areas.
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Affiliation(s)
- Janne M. Veerbeek
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- *Correspondence: Janne M. Veerbeek
| | - Johannes Pohl
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
| | - Jeremia P. O. Held
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
| | - Andreas R. Luft
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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Widmer M, Held JPO, Wittmann F, Valladares B, Lambercy O, Sturzenegger C, Palla A, Lutz K, Luft AR. Reward During Arm Training Improves Impairment and Activity After Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:140-150. [PMID: 34937456 PMCID: PMC8796156 DOI: 10.1177/15459683211062898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Learning and learning-related neuroplasticity in motor cortex are potential mechanisms mediating recovery of movement abilities after stroke. These mechanisms depend on dopaminergic projections from midbrain that may encode reward information. Likewise, therapist experience confirms the role of feedback/reward for training efficacy after stroke. OBJECTIVE To test the hypothesis that rehabilitative training can be enhanced by adding performance feedback and monetary rewards. METHODS This multicentric, assessor-blinded, randomized controlled trial used the ArmeoSenso virtual reality rehabilitation system to train 37 first-ever subacute stroke patients in arm-reaching to moving targets. The rewarded group (n = 19) trained with performance feedback (gameplay) and contingent monetary reward. The control group (n = 18) used the same system without monetary reward and with graphically minimized performance feedback. Primary outcome was the change in the two-dimensional reaching space until the end of the intervention period. Secondary clinical assessments were performed at baseline, after 3 weeks of training (15 1-hour sessions), and at 3 month follow-up. Duration and intensity of the interventions as well as concomitant therapy were comparable between groups. RESULTS The two-dimensional reaching space showed an overall improvement but no difference between groups. The rewarded group, however, showed significantly greater improvements from baseline in secondary outcomes assessing arm activity (Box and Block Test at post-training: 6.03±2.95, P = .046 and 3 months: 9.66±3.11, P = .003; Wolf Motor Function Test [Score] at 3 months: .63±.22, P = .007) and arm impairment (Fugl-Meyer Upper Extremity at 3 months: 8.22±3.11, P = .011). CONCLUSIONS Although neutral in its primary outcome, the trial signals a potential facilitating effect of reward on training-mediated improvement of arm paresis. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT02257125).
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Affiliation(s)
- Mario Widmer
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
- cereneo Advanced Rehabilitation Institute (CARINg), Vitznau, Switzerland
- Department of Therapy, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Frieder Wittmann
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Belen Valladares
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian Sturzenegger
- Klinik Lengg, Zürcher RehaZentren, Zurich, Switzerland
- Bellikon Rehabilitation Clinic, Bellikon, Switzerland
| | - Antonella Palla
- Klinik Wald, Zürcher RehaZentren, Wald, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Kai Lutz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
- squipe GmbH, Wädenswil, Switzerland
| | - Andreas R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
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Schwarz A, Bhagubai MMC, Nies SHG, Held JPO, Veltink PH, Buurke JH, Luft AR. Characterization of stroke-related upper limb motor impairments across various upper limb activities by use of kinematic core set measures. J Neuroeng Rehabil 2022; 19:2. [PMID: 35016694 PMCID: PMC8753836 DOI: 10.1186/s12984-021-00979-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Upper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases. Method Chronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effects of the factors gesture versus grasp movements, and the impairment level on the kinematics of the whole task were tested. Similarities considering the metrics expressions and relations were investigated for the subphases of reaching proximally and distally between tasks and subgroups. Results Data of 26 stroke and 5 healthy subjects were included. Gesture and grasp movements were differently expressed across subjects. Gestures were performed with larger shoulder motions besides higher peak velocity. Grasp movements were expressed by larger trunk, forearm, and wrist motions. Trunk displacement, movement time, and NVP increased and shoulder flexion/extension decreased significantly with increased impairment level. Across tasks, phases of reaching distally were comparable in terms of trunk displacement, shoulder motions and peak velocity, while reaching proximally showed comparable expressions in trunk motions. Consistent metric relations during reaching distally were found between shoulder flexion/extension, elbow flexion/extension, peak velocity, and between movement time, NVP, and SPARC. Reaching proximally revealed reproducible correlations between forearm pronation/supination and wrist flexion/extension, movement time and NVP. Conclusion Spatiotemporal differences between gestures versus grasp movements and between different impairment levels were confirmed. The consistencies of metric expressions during movement subphases across tasks can be useful for linking kinematic assessment standards and daily living measures in future research and performing task and study comparisons. Trial registration: ClinicalTrials.gov Identifier NCT03135093. Registered 26 April 2017, https://clinicaltrials.gov/ct2/show/NCT03135093.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.
| | - Miguel M C Bhagubai
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Saskia H G Nies
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter H Veltink
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.,Roessingh Research and Development B.V., Enschede, The Netherlands
| | - Andreas R Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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11
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Held JPO, Schwarz A, Pohl J, Thürlimann E, Porrtmann S, Branscheidt M, Fratian M, Van Duinen J, Veerbeek JM, Luft AR. Changes in stroke rehabilitation during the SARS-CoV-2 shutdown in Switzerland. J Rehabil Med 2021; 54:jrm00272. [PMID: 34927210 PMCID: PMC8902586 DOI: 10.2340/jrm.v53.1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Many stroke survivors require continuous outpatient rehabilitation therapy to maintain or improve their neurological functioning, independence, and quality of life. In Switzerland and many other countries, the shutdown to contain SARS-CoV-2 infections led to mobility restrictions and a decrease in therapy delivery. This study investigated the impact of the COVID-19 shutdown on stroke survivors’ access to therapy, physical activity, functioning and mood. Methods A prospective observational cohort study in stroke subjects. At 4 time-points (before, during, after the shutdown, and at 3-month follow-up), the amount of therapy, physical activities, motor function, anxiety, and depression were assessed. Results Thirty-six community-dwelling stroke subjects (median 70 years of age, 10 months post-stroke) were enrolled. Therapy reductions related to the shutdown were reported in 72% of subjects. This decrease was associated with significantly extended sedentary time and minimal deterioration in physical activity during the shutdown. Both parameters improved between reopening and 3-month follow-up. Depressive symptoms increased slightly during the observation period. Patients more frequently reported on self-directed training during shutdown. Conclusion The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-stroke outcomes, except for depression. Importantly, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.
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Affiliation(s)
- Jeremia P O Held
- University and University Hospital Zurich, Neurology, Frauenklinikstrasse 26, 8091 Zurich.
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12
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Huber SK, Held JPO, de Bruin ED, Knols RH. Personalized Motor-Cognitive Exergame Training in Chronic Stroke Patients-A Feasibility Study. Front Aging Neurosci 2021; 13:730801. [PMID: 34744688 PMCID: PMC8565485 DOI: 10.3389/fnagi.2021.730801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose: Exergame training may be beneficial for improving long-term outcome in stroke patients. Personalized training prescription applying progression rules, is missing. We adapted a theory-based taxonomy for a rehabilitation approach using user-centered exergames. The aims were primarily to investigate the feasibility of this rehabilitation approach, and secondarily to evaluate its performance of personalizing training progression, as well as explore the effects on secondary outcomes. Methods: Chronic stroke patients (≥ 18 years) were included, who were able to walk 10 meters and stand for 3 min. The rehabilitation approach was administered twice per week for 8 weeks. As primary outcome, feasibility was evaluated by comparing achieved rates of inclusion, adherence, compliance, attrition, motivation, and satisfaction to pre-defined thresholds for acceptance. Secondary outcomes were (1) perceived motor and cognitive task difficulty throughout the intervention; (2) measures collected during baseline and post-measurements—a gait analysis, the Timed-up-and-go test (TUG), several cognitive tests assessing attentional, executive, and visuospatial functions. Results: Thirteen patients [median: 68.0 (IQR: 49.5–73.5) years, median: 34.5 (IQR: 12.25–90.75) months post-stroke] were included, of whom ten completed the study. Rates for inclusion (57%), adherence (95%), compliance (99%), motivation (77%), and satisfaction (74%) were acceptable, however, the attrition rate was high (23%). The perceived motor and cognitive task difficulty predominantly moved below the targeted range. We found a significant change in the TUG (p = 0.05, r = 0.46) and medium-to-large effect sizes (p > 0.05) for swing time of the affected leg, the asymmetry index, time needed for the Trail-making test (TMT) A and accuracy for the TMT B and the Mental Rotation Test (MRT; 0.26 ≤ r ≤ 0.46). Discussion: The intervention was feasible with minor modifications necessary, which warrants a larger trial investigating the effects of the rehabilitation approach following the adapted taxonomy on mobility, gait and cognitive functions. Two main limitations of the rehabilitation approach were; (1) the taxonomy decoupled motor and cognitive progression, which may be improper as motor and cognitive learning is coupled; (2) separate subjective ratings were used to guide the progression. Future studies should develop an instrument to objectively assess motor-cognitive task difficulty for monitoring the progression of an exergame-based training.
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Affiliation(s)
- Simone K Huber
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Department of Health Science and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Science and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Health, OST-Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Department of Health Science and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland
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13
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Averta G, Barontini F, Catrambone V, Haddadin S, Handjaras G, Held JPO, Hu T, Jakubowitz E, Kanzler CM, Kühn J, Lambercy O, Leo A, Obermeier A, Ricciardi E, Schwarz A, Valenza G, Bicchi A, Bianchi M. U-Limb: A multi-modal, multi-center database on arm motion control in healthy and post-stroke conditions. Gigascience 2021; 10:giab043. [PMID: 34143875 PMCID: PMC8212873 DOI: 10.1093/gigascience/giab043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Shedding light on the neuroscientific mechanisms of human upper limb motor control, in both healthy and disease conditions (e.g., after a stroke), can help to devise effective tools for a quantitative evaluation of the impaired conditions, and to properly inform the rehabilitative process. Furthermore, the design and control of mechatronic devices can also benefit from such neuroscientific outcomes, with important implications for assistive and rehabilitation robotics and advanced human-machine interaction. To reach these goals, we believe that an exhaustive data collection on human behavior is a mandatory step. For this reason, we release U-Limb, a large, multi-modal, multi-center data collection on human upper limb movements, with the aim of fostering trans-disciplinary cross-fertilization. CONTRIBUTION This collection of signals consists of data from 91 able-bodied and 65 post-stroke participants and is organized at 3 levels: (i) upper limb daily living activities, during which kinematic and physiological signals (electromyography, electro-encephalography, and electrocardiography) were recorded; (ii) force-kinematic behavior during precise manipulation tasks with a haptic device; and (iii) brain activity during hand control using functional magnetic resonance imaging.
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Affiliation(s)
- Giuseppe Averta
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Federica Barontini
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Vincenzo Catrambone
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
| | - Sami Haddadin
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Giacomo Handjaras
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Jeremia P O Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, Frauenklinikstrasse 26, 8006 Zürich, Switzerland
| | - Tingli Hu
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Eike Jakubowitz
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, L384, 30625 Hannover, Germany
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, CLA H 1.1 Tannenstrasse 3, 8092 Zurich, Switzerland
| | - Johannes Kühn
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, CLA H 1.1 Tannenstrasse 3, 8092 Zurich, Switzerland
| | - Andrea Leo
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Alina Obermeier
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, L384, 30625 Hannover, Germany
| | - Emiliano Ricciardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, Frauenklinikstrasse 26, 8006 Zürich, Switzerland
| | - Gaetano Valenza
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
| | - Antonio Bicchi
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Matteo Bianchi
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
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14
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Ranzani R, Eicher L, Viggiano F, Engelbrecht B, Held JPO, Lambercy O, Gassert R. Towards a Platform for Robot-Assisted Minimally-Supervised Therapy of Hand Function: Design and Pilot Usability Evaluation. Front Bioeng Biotechnol 2021; 9:652380. [PMID: 33937218 PMCID: PMC8082072 DOI: 10.3389/fbioe.2021.652380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background Robot-assisted therapy can increase therapy dose after stroke, which is often considered insufficient in clinical practice and after discharge, especially with respect to hand function. Thus far, there has been a focus on rather complex systems that require therapist supervision. To better exploit the potential of robot-assisted therapy, we propose a platform designed for minimal therapist supervision, and present the preliminary evaluation of its immediate usability, one of the main and frequently neglected challenges for real-world application. Such an approach could help increase therapy dose by allowing the training of multiple patients in parallel by a single therapist, as well as independent training in the clinic or at home. Methods We implemented design changes on a hand rehabilitation robot, considering aspects relevant to enabling minimally-supervised therapy, such as new physical/graphical user interfaces and two functional therapy exercises to train hand motor coordination, somatosensation and memory. Ten participants with chronic stroke assessed the usability of the platform and reported the perceived workload during a single therapy session with minimal supervision. The ability to independently use the platform was evaluated with a checklist. Results Participants were able to independently perform the therapy session after a short familiarization period, requiring assistance in only 13.46 (7.69–19.23)% of the tasks. They assigned good-to-excellent scores on the System Usability Scale to the user-interface and the exercises [85.00 (75.63–86.88) and 73.75 (63.13–83.75) out of 100, respectively]. Nine participants stated that they would use the platform frequently. Perceived workloads lay within desired workload bands. Object grasping with simultaneous control of forearm pronosupination and stiffness discrimination were identified as the most difficult tasks. Discussion Our findings demonstrate that a robot-assisted therapy device can be rendered safely and intuitively usable upon first exposure with minimal supervision through compliance with usability and perceived workload requirements. The preliminary usability evaluation identified usability challenges that should be solved to allow real-world minimally-supervised use. Such a platform could complement conventional therapy, allowing to provide increased dose with the available resources, and establish a continuum of care that progressively increases therapy lead of the patient from the clinic to the home.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Lucas Eicher
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Federica Viggiano
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | | | - Jeremia P O Held
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
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15
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Schwarz A, Veerbeek JM, Held JPO, Buurke JH, Luft AR. Measures of Interjoint Coordination Post-stroke Across Different Upper Limb Movement Tasks. Front Bioeng Biotechnol 2021; 8:620805. [PMID: 33585418 PMCID: PMC7876346 DOI: 10.3389/fbioe.2020.620805] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/18/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Deficits in interjoint coordination, such as the inability to move out of synergy, are frequent symptoms in stroke subjects with upper limb impairments that hinder them from regaining normal motor function. Kinematic measurements allow a fine-grained assessment of movement pathologies, thereby complementing clinical scales, like the Fugl–Meyer Motor Assessment of the Upper Extremity (FMMA-UE). The study goal was to investigate the effects of the performed task, the tested arm, the dominant affected hand, upper limb function, and age on spatiotemporal parameters of the elbow, shoulder, and trunk. The construct validity of the metrics was examined by relating them with each other, the FMMA-UE, and its arm section. Methods: This is a cross-sectional observational study including chronic stroke patients with mild to moderate upper limb motor impairment. Kinematic measurements were taken using a wearable sensor suit while performing four movements with both upper limbs: (1) isolated shoulder flexion, (2) pointing, (3) reach-to-grasp a glass, and (4) key insertion. The kinematic parameters included the joint ranges of shoulder abduction/adduction, shoulder flexion/extension, and elbow flexion/extension; trunk displacement; shoulder–elbow correlation coefficient; median slope; and curve efficiency. The effects of the task and tested arm on the metrics were investigated using a mixed-model analysis. The validity of metrics compared to clinically measured interjoint coordination (FMMA-UE) was done by correlation analysis. Results: Twenty-six subjects were included in the analysis. The movement task and tested arm showed significant effects (p < 0.05) on all kinematic parameters. Hand dominance resulted in significant effects on shoulder flexion/extension and curve efficiency. The level of upper limb function showed influences on curve efficiency and the factor age on median slope. Relations with the FMMA-UE revealed the strongest and significant correlation for curve efficiency (r = 0.75), followed by shoulder flexion/extension (r = 0.68), elbow flexion/extension (r = 0.53), and shoulder abduction/adduction (r = 0.49). Curve efficiency additionally correlated significantly with the arm subsection, focusing on synergistic control (r = 0.59). Conclusion: The kinematic parameters of the upper limb after stroke were influenced largely by the task. These results underpin the necessity to assess different relevant functional movements close to real-world conditions rather than relying solely on clinical measures. Study Registration: clinicaltrials.gov, identifier NCT03135093 and BASEC-ID 2016-02075.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Biomedical Signals and Systems (BSS), University of Twente, Enschede, Netherlands
| | - Janne M Veerbeek
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jaap H Buurke
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, Netherlands.,Roessingh Research and Development B.V., Enschede, Netherlands
| | - Andreas R Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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16
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Bhagubai MMC, Wolterink G, Schwarz A, Held JPO, Van Beijnum BJF, Veltink PH. Quantifying Pathological Synergies in the Upper Extremity of Stroke Subjects With the Use of Inertial Measurement Units: A Pilot Study. IEEE J Transl Eng Health Med 2020; 9:2100211. [PMID: 33344099 PMCID: PMC7742824 DOI: 10.1109/jtehm.2020.3042931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Stroke is one of the main causes of disability in the world, causing loss of motor function on mainly one side of the body. A proper assessment of motor function is required to help to direct and evaluate therapy. Assessment is currently performed by therapists using observer-based standardized clinical assessment protocols. Sensor-based technologies can be used to objectively quantify the presence and severity of motor impairments in stroke patients. METHODS In this work, a minimally obstructive distributed inertial sensing system, intended to measure kinematics of the upper extremity, was developed and tested in a pilot study, where 10 chronic stroke subjects performed the arm-related tasks from the Fugl-Meyer Assessment protocol with the affected and non-affected side. RESULTS The pilot study showed that the developed distributed measurement system was adequately sensitive to show significant differences in stroke subjects' arm postures between the affected and non-affected side. The presence of pathological synergies can be analysed using the measured joint angles of the upper limb segments, that describe the movement patterns of the subject. CONCLUSION Features measured by the system vary from the assessed FMA-UE sub-score showing its potential to provide more detailed clinical information.
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Affiliation(s)
- Miguel M C Bhagubai
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
| | - Gerjan Wolterink
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands.,Robotics and Mechatronics GroupUniversity of Twente7522NHEnschedeThe Netherlands
| | - Anne Schwarz
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands.,Division of Vascular Neurology and NeurorehabilitationDepartment of NeurologyUniversity Hospital Zürich, University of Zürich8091ZürichSwitzerland
| | - Jeremia P O Held
- Division of Vascular Neurology and NeurorehabilitationDepartment of NeurologyUniversity Hospital Zürich, University of Zürich8091ZürichSwitzerland
| | - Bert-Jan F Van Beijnum
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
| | - Peter H Veltink
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
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Kanzler CM, Schwarz A, Held JPO, Luft AR, Gassert R, Lambercy O. Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals. J Neuroeng Rehabil 2020; 17:128. [PMID: 32977810 PMCID: PMC7517659 DOI: 10.1186/s12984-020-00748-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Assessing arm and hand sensorimotor impairments that are functionally relevant is essential to optimize the impact of neurorehabilitation interventions. Technology-aided assessments should provide a sensitive and objective characterization of upper limb impairments, but often provide arm weight support and neglect the importance of the hand, thereby questioning their functional relevance. The Virtual Peg Insertion Test (VPIT) addresses these limitations by quantifying arm and hand movements as well as grip forces during a goal-directed manipulation task requiring active lifting of the upper limb against gravity. The aim of this work was to evaluate the ability of the VPIT metrics to characterize arm and hand sensorimotor impairments that are relevant for performing functional tasks. METHODS Arm and hand sensorimotor impairments were systematically characterized in 30 chronic stroke patients using conventional clinical scales and the VPIT. For the latter, ten previously established kinematic and kinetic core metrics were extracted. The validity and robustness of these metrics was investigated by analyzing their clinimetric properties (test-retest reliability, measurement error, learning effects, concurrent validity). RESULTS Twenty-three of the participants, the ones with mild to moderate sensorimotor impairments and without strong cognitive deficits, were able to successfully complete the VPIT protocol (duration 16.6 min). The VPIT metrics detected impairments in arm and hand in 90.0% of the participants, and were sensitive to increased muscle tone and pathological joint coupling. Most importantly, significant moderate to high correlations between conventional scales of activity limitations and the VPIT metrics were found, thereby indicating their functional relevance when grasping and transporting objects, and when performing dexterous finger manipulations. Lastly, the robustness of three out of the ten VPIT core metrics in post-stroke individuals was confirmed. CONCLUSIONS This work provides evidence that technology-aided assessments requiring goal-directed manipulations without arm weight support can provide an objective, robust, and clinically feasible way to assess functionally relevant sensorimotor impairments in arm and hand in chronic post-stroke individuals with mild to moderate deficits. This allows for a better identification of impairments with high functional relevance and can contribute to optimizing the functional benefits of neurorehabilitation interventions.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
| | - Roger Gassert
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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18
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Schwarz A, Bhagubai MMC, Wolterink G, Held JPO, Luft AR, Veltink PH. Assessment of Upper Limb Movement Impairments after Stroke Using Wearable Inertial Sensing. Sensors (Basel) 2020; 20:s20174770. [PMID: 32846958 PMCID: PMC7506737 DOI: 10.3390/s20174770] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/23/2022]
Abstract
Precise and objective assessments of upper limb movement quality after strokes in functional task conditions are an important prerequisite to improve understanding of the pathophysiology of movement deficits and to prove the effectiveness of interventions. Herein, a wearable inertial sensing system was used to capture movements from the fingers to the trunk in 10 chronic stroke subjects when performing reach-to-grasp activities with the affected and non-affected upper limb. It was investigated whether the factors, tested arm, object weight, and target height, affect the expressions of range of motion in trunk compensation and flexion-extension of the elbow, wrist, and finger during object displacement. The relationship between these metrics and clinically measured impairment was explored. Nine subjects were included in the analysis, as one had to be excluded due to defective data. The tested arm and target height showed strong effects on all metrics, while an increased object weight showed effects on trunk compensation. High inter- and intrasubject variability was found in all metrics without clear relationships to clinical measures. Relating all metrics to each other resulted in significant negative correlations between trunk compensation and elbow flexion-extension in the affected arm. The findings support the clinical usability of sensor-based motion analysis.
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Affiliation(s)
- Anne Schwarz
- Biomedical Signals and Systems (BSS), University of Twente, 7500 AE Enschede, The Netherlands; (M.M.C.B.); (G.W.); (P.H.V.)
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.P.O.H.); (A.R.L.)
- Correspondence:
| | - Miguel M. C. Bhagubai
- Biomedical Signals and Systems (BSS), University of Twente, 7500 AE Enschede, The Netherlands; (M.M.C.B.); (G.W.); (P.H.V.)
| | - Gerjan Wolterink
- Biomedical Signals and Systems (BSS), University of Twente, 7500 AE Enschede, The Netherlands; (M.M.C.B.); (G.W.); (P.H.V.)
- Robotics and Mechatronics group, University of Twente, 7500 AE Enschede, The Netherlands
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.P.O.H.); (A.R.L.)
| | - Andreas R. Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.P.O.H.); (A.R.L.)
- Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
| | - Peter H. Veltink
- Biomedical Signals and Systems (BSS), University of Twente, 7500 AE Enschede, The Netherlands; (M.M.C.B.); (G.W.); (P.H.V.)
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19
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Kanzler CM, Rinderknecht MD, Schwarz A, Lamers I, Gagnon C, Held JPO, Feys P, Luft AR, Gassert R, Lambercy O. A data-driven framework for selecting and validating digital health metrics: use-case in neurological sensorimotor impairments. NPJ Digit Med 2020; 3:80. [PMID: 32529042 PMCID: PMC7260375 DOI: 10.1038/s41746-020-0286-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Digital health metrics promise to advance the understanding of impaired body functions, for example in neurological disorders. However, their clinical integration is challenged by an insufficient validation of the many existing and often abstract metrics. Here, we propose a data-driven framework to select and validate a clinically relevant core set of digital health metrics extracted from a technology-aided assessment. As an exemplary use-case, the framework is applied to the Virtual Peg Insertion Test (VPIT), a technology-aided assessment of upper limb sensorimotor impairments. The framework builds on a use-case-specific pathophysiological motivation of metrics, models demographic confounds, and evaluates the most important clinimetric properties (discriminant validity, structural validity, reliability, measurement error, learning effects). Applied to 77 metrics of the VPIT collected from 120 neurologically intact and 89 affected individuals, the framework allowed selecting 10 clinically relevant core metrics. These assessed the severity of multiple sensorimotor impairments in a valid, reliable, and informative manner. These metrics provided added clinical value by detecting impairments in neurological subjects that did not show any deficits according to conventional scales, and by covering sensorimotor impairments of the arm and hand with a single assessment. The proposed framework provides a transparent, step-by-step selection procedure based on clinically relevant evidence. This creates an interesting alternative to established selection algorithms that optimize mathematical loss functions and are not always intuitive to retrace. This could help addressing the insufficient clinical integration of digital health metrics. For the VPIT, it allowed establishing validated core metrics, paving the way for their integration into neurorehabilitation trials.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Mike D. Rinderknecht
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Ilse Lamers
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreas R. Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
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20
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Schwarz A, Averta G, Veerbeek JM, Luft AR, Held JPO, Valenza G, Biechi A, Bianchi M. A functional analysis-based approach to quantify upper limb impairment level in chronic stroke patients: a pilot study. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:4198-4204. [PMID: 31946795 DOI: 10.1109/embc.2019.8857732] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The accurate assessment of upper limb motion impairment induced by stroke - which represents one of the primary causes of disability world-wide - is the first step to successfully monitor and guide patients' recovery. As of today, the majority of the procedures relies on clinical scales, which are mostly based on ordinal scaling, operator-dependent, and subject to floor and ceiling effects. In this work, we intend to overcome these limitations by proposing a novel approach to analytically evaluate the level of pathological movement coupling, based on the quantification of movement complexity. To this goal, we consider the variations of functional Principal Components applied to the reconstruction of joint angle trajectories of the upper limb during daily living task execution, and compared these variations between two conditions, i.e. the affected and non-affected arm. A Dissimilarity Index, which codifies the severity of the upper limb motor impairment with respect to the movement complexity of the non-affected arm, is then proposed. This methodology was validated as a proof of concept upon a set of four chronic stroke subjects with mild to moderate arm and hand impairments. As a first step, we evaluated whether the derived outcomes differentiate between the two conditions upon the whole data-set. Secondly, we exploited this concept to discern between different subjects and impairment levels. Results show that: i) differences in terms of movement variability between the affected and nonaffected upper limb are detectable and ii) different impairment profiles can be characterized for single subjects using the proposed approach. Although provisional, these results are very promising and suggest this approach as a basis ingredient for the definition of a novel, operator-independent, sensitive, intuitive and widely applicable scale for the evaluation of upper limb motion impairment.
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21
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Ciullo AS, Veerbeek JM, Temperli E, Luft AR, Tonis FJ, Haarman CJW, Ajoudani A, Catalano MG, Held JPO, Bicchi A. A Novel Soft Robotic Supernumerary Hand for Severely Affected Stroke Patients. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1168-1177. [PMID: 32248115 DOI: 10.1109/tnsre.2020.2984717] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Upper limb functions are severely affected in 23% of the chronic stroke patients, compromising their life quality. To re-enable hand use, providing a degree of functionality and motivating against learned non-use, we propose a robotic supernumerary limb, the SoftHand X (SHX), consisting of a robotic hand, a gravity support system, and different sensors to detect the patient's intent for controlling the robotic hand. In this paper, this novel compensational approach is introduced and experimentally evaluated in stroke patients, assessing its efficacy, usability and safety. Ten patients were asked to perform tasks of a modified Action Research Arm Test with the SHX, by using three input methods. The mARAT scores rated the potentiality of the system. Usability was evaluated with the System Usability Scale, while spasticity before and after use was measured by the modified Ashworth Scale (mAS). Nine patients, not able to perform any tasks without external support, completed the whole experimental procedure using the proposed system with a median score greater than 12/30. Among the three input methods tested, the usability of one was rated as "good" while the other two were rated as "ok". Seven patients exhibited a reduction of the mAS. All nine patients stated that they would use the system frequently. Results obtained suggest that the SHX has the potential to partially compensate severely impaired hand function in stroke patients.
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22
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Ranzani R, Viggiano F, Engelbrecht B, Held JPO, Lambercy O, Gassert R. Method for Muscle Tone Monitoring During Robot-Assisted Therapy of Hand Function: A Proof of Concept. IEEE Int Conf Rehabil Robot 2020; 2019:957-962. [PMID: 31374753 DOI: 10.1109/icorr.2019.8779454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Robot-assisted rehabilitation of hand function is becoming an established approach to complement conventional therapy after stroke, particularly in view of its possible unsupervised use to promote an increase in therapy dose. Given their intensive therapy regime, robots may promote a temporary increase in hand muscle tone and spasticity, which may cause pain and negatively affect recovery. To integrate hand muscle tone monitoring into an assessment-driven robot-assisted therapy concept, an online assessment of muscle tone is proposed and incorporated into an exercise. The exercise was preliminarily tested in a pilot study with five chronic stroke survivors (non-spastic at rest) and five healthy participants to identify the range of potential physiological muscle tone change that can happen also in a non-spastic population during a single exercise session. In both groups, the muscle tone level during hand opening was higher in fast 20 mm ramp-and-hold perturbations (150 ms) compared to slow (250 ms) perturbations, and corresponded to a force change of approximately 4-5 N. Despite not being statistically significantly different, in the stroke group the force change (and the speed dependency) increased with exercise time. This information could serve as a basis to develop strategies to continuously adapt the difficulty and activity level required in robot-assisted rehabilitation and to monitor or even control the muscle tone evolution over time.
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23
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Held JPO, van Duinen J, Luft AR, Veerbeek JM. Eligibility Screening for an Early Upper Limb Stroke Rehabilitation Study. Front Neurol 2019; 10:683. [PMID: 31312170 PMCID: PMC6614516 DOI: 10.3389/fneur.2019.00683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stroke rehabilitation should start early in order to optimize patients' outcomes, but most trials include subacute or chronic patients. Although suggested that early stroke rehabilitation trials face difficulties regarding patient recruitment with corresponding low recruitment rates, no systematically collected information regarding screening and associated costs has been published. Such knowledge is essential for optimizing enrollment. Therefore, this study evaluated screening procedures for an early upper limb rehabilitation study including first-ever ischemic stroke patients <48 h after onset. Methods: Screening data for a monocentric longitudinal observational cohort study was prospectively collected. Researchers screened health-care records, during the morning round and face-to-face at the stroke-unit on working days. Outcomes were the recruitment rate, reasons for non-enrollment, and screening costs. Results: Over 15 months, 27 out of 845 screened ischemic stroke patients were enrolled, equaling a recruitment rate of 1.8/month. Main reasons for non-enrollment were no upper limb paresis (N = 456), >48 h post-stroke (N = 257), general comorbidity (N = 150), unable to follow commands (N = 148), and recurrent stroke (N = 146). Four patients were missed due to time constraints of the personnel or patient. The recruitment rate would have been 1.2 higher if also patients with recurrent strokes but without residual motor deficits or pre-stroke mRS ≥2 were considered eligible. Screening costed € 7.48 per patient. Discussion: Screening at working days is sufficient to enroll patients in early stroke rehabilitation trials. Inclusion criteria regarding recurrent strokes should be less stringent to boost recruitment rates without increasing bias. Multicenter collaborations are needed to finish well-powered early stroke rehabilitation studies within a reasonable time. Ethics and Study Registration: Authorization from the local ethical committee was not required, as this study does not fall within the scope of the Human Research Act (BASEC Identifier: Req-2017-00844). The project was registered at http://www.clinicaltrials.gov (Identifier: NCT03633422).
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Affiliation(s)
- Jeremia P O Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Jannie van Duinen
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Janne M Veerbeek
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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24
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Held JPO, Klaassen B, Eenhoorn A, van Beijnum BJF, Buurke JH, Veltink PH, Luft AR. Inertial Sensor Measurements of Upper-Limb Kinematics in Stroke Patients in Clinic and Home Environment. Front Bioeng Biotechnol 2018; 6:27. [PMID: 29707537 PMCID: PMC5906540 DOI: 10.3389/fbioe.2018.00027] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/06/2018] [Indexed: 01/13/2023] Open
Abstract
Background Upper-limb impairments in stroke patients are usually measured in clinical setting using standard clinical assessment. In addition, kinematic analysis using opto-electronic systems has been used in the laboratory setting to map arm recovery. Such kinematic measurements cannot capture the actual function of the upper extremity in daily life. The aim of this study is to longitudinally explore the complementarity of post-stroke upper-limb recovery measured by standard clinical assessments and daily-life recorded kinematics. Methods The study was designed as an observational, single-group study to evaluate rehabilitation progress in a clinical and home environment, with a full-body sensor system in stroke patients. Kinematic data were recorded with a full-body motion capture suit during clinical assessment and self-directed activities of daily living. The measurements were performed at three time points for 3 h: (1) 2 weeks before discharge of the rehabilitation clinic, (2) right after discharge, and (3) 4 weeks after discharge. The kinematic analysis of reaching movements uses the position and orientation of each body segment to derive the joint angles. Newly developed metrics for classifying activity and quality of upper extremity movement were applied. Results The data of four stroke patients (three mildly impaired, one sever impaired) were included in this study. The arm motor function assessment improved during the inpatient rehabilitation, but declined in the first 4 weeks after discharge. A change in the data (kinematics and new metrics) from the daily-life recording was seen in in all patients. Despite this worsening patients increased the number of reaches they performed during daily life in their home environment. Conclusion It is feasible to measure arm kinematics using Inertial Measurement Unit sensors during daily life in stroke patients at the different stages of rehabilitation. Our results from the daily-life recordings complemented the data from the clinical assessments and illustrate the potential to identify stroke patient characteristics, based on kinematics, reaching counts, and work area. Clinical Trial Registration https://clinicaltrials.gov, identifier NCT02118363.
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Affiliation(s)
- Jeremia P O Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.,Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands.,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Bart Klaassen
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Albert Eenhoorn
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Bert-Jan F van Beijnum
- Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
| | - Jaap H Buurke
- Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands.,Roessingh Research and Development B.V., Enschede, Netherlands
| | - Peter H Veltink
- Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
| | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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Held JPO, Luft AR, Veerbeek JM. Encouragement-Induced Real-World Upper Limb Use after Stroke by a Tracking and Feedback Device: A Study Protocol for a Multi-Center, Assessor-Blinded, Randomized Controlled Trial. Front Neurol 2018; 9:13. [PMID: 29422881 PMCID: PMC5788891 DOI: 10.3389/fneur.2018.00013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Retraining the paretic upper limb after stroke should be intense and specific to be effective. Hence, the best training is daily life use, which is often limited by motivation and effort. Tracking and feedback technology have the potential to encourage self-administered, context-specific training of upper limb use in the patients’ home environment. The aim of this study is to investigate post-intervention and long-term effects of a wrist-worn activity tracking device providing multimodal feedback on daily arm use in hemiparetic subjects beyond 3 months post-stroke. Methods and analysis A prospective, multi-center, assessor-blinded, Phase 2 randomized controlled trial with a superiority framework. Sixty-two stroke patients will be randomized in two groups with a 1:1 allocation ratio, stratified based on arm paresis severity (Fugl-Meyer Assessment—Upper Extremity subscale <32 and ≥32). The experimental group receives a wrist-worn activity tracking device providing multimodal feedback on daily arm use for 6 weeks. Controls wear an identical device providing no feedback. Sample size: 31 participants per group, based on a difference of 0.75±1.00 points on the Motor Activity Log—14 Item Version, Amount of Use subscale (MAL—14 AOU), 80% power, two-sided alpha of 0.05, and a 10% attrition rate. Outcomes: primary outcome is the change in patient-reported amount of daily life upper limb use (MAL—14 AOU) from baseline to post-intervention. Secondary outcomes are change in upper limb motor function, upper limb capacity, global disability, patient-reported quality of daily life upper limb use, and quality of life from baseline to post-intervention and 6-week follow-up, as well as compliance, activity counts, and safety. Discussion The results of this study will show the possible efficacy of a wrist-worn tracking and feedback device on patient-reported amount of daily life upper limb use. Ethics and dissemination The study is approved by the Cantonal Ethics Committees Zurich, and Northwest and Central Switzerland (BASEC-number 2017-00948) and registered in https://clinicaltrials.gov (NCT03294187) before recruitment started. This study will be carried out in compliance with the Declaration of Helsinki, ICH-GCP, ISO 14155:2011, and Swiss legal and regulatory requirements. Dissemination will include submission to a peer-reviewed journal, patient and healthcare professional magazines, and congress presentations.
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Affiliation(s)
- Jeremia P O Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Cereneo, center for Neurology and Rehabilitation, Vitznau, Switzerland.,Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
| | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Cereneo, center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Janne M Veerbeek
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Cereneo, center for Neurology and Rehabilitation, Vitznau, Switzerland
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